OPHTHALMIA

NEONATORUM

DEFINITION
Ophthalmia neonatorum is defined as conjunctival inflammation occurs within the first 30 days of life. It may be infective or non infective

SYMPTOMS
Redness Discharge (may be profuse in gonococcal infection) Swelling of lids (may be severe) Symptoms usually bilateral

ETIOLOGY
The three main etiologies of neonatal conjunctivitis include: Chemical Bacterial Viral

CHEMICAL
the most common cause of neonatal conjunctivitis due to use of post-delivery use of ophthalmic silver nitrate used in the prophylaxis of ocular gonococcal infections

Onset in hours, lasts 24 hours

Creds treatment consists of instilling 1% tetracycline ointment, 0.5%

erythromycin ophthalmic ointment, or 1% silver nitrate into the neonates eyes to prevent damage and blindness from conjunctivitis caused by Neisseria gonorrhoeae

Povidone-iodine 2.5% ophthalmic solution may be ideal prophylaxis.

Isenberg SJ, Apt L, Wood M. A controlled trial of povidone-iodine as prophylaxis against ophthalmia neonatorum. N Engl J Med 1995;332:5626. [PubMed]

INFECTION
Source and mode of infection 1 . Before birth infection 2. During birth. 3. After birth. Infection may occur during first bath of newborn or from soiled clothes or fingers with infected lochia

CHALMYDIA
Infants whose mothers have untreated chlamydial infections antepartum have a 30% to 40% chance of developing chlamydial neonatal conjunctivitis postpartum Perinatal chlamydial exposure may also cause localized infection in the nasopharynx, middle ear, vagina, and rectum .

CHALMYDIA
5 to 14 days af ter bir th (some repor t up to 28 days af ter bir th):

unilateral/bilateral water y conjunctivitis becoming purulent, papillar y

reaction , +/- pseudomembranes , corneal scarring Complications : pneumonia, otitis media, rhinitis, GIT infection . DIAGNOSIS ELISA , Giemsa, culture, direct immunofluorescent antibodies (fastest). PCR TREATM ENT
Neonate- 50mg/kg erythromycin in 4 divided doses for 3 weeks, topical G tetracycline 1%
Adults- 250mg QDS erythromycin for 3 weeks Prophylaxis- c tetracycline or c erythromycin within 1hr after birth

GONOCOCCAL CONJUNCTIVITIS
N. gonorrhoeae is a gram-negative diplococcus. Gonococci have the ability to penetrate intact epithelial cells, and once inside the cell, they divide rapidly.

a hyperacute conjunctivitis associated with marked lid edema, chemosis, and purulent discharge, beginning 24 to 48 hours after birth.

Conjunctival membranes may be present. With a delay in diagnosis, corneal ulceration may occur and can rapidly progress to perforation.

Cloudy cornea without ulcer in neonatal gonococcal conjunctivitis.

 Complications: corneal perforation, septic,arthritis, sepsis, meningitis DIAGNOSIS Gram stain (intracellular diplococci), ( culture ) Treatment- Ceftriaxone 25-50mg/kg x one or 14 days if disseminated infection.
Irrigation with saline sol.

HERPES SIMPLEX
70% of neonatal herpetic infections have been attributed to the genital strain, HSV-2 Most neonatal HSV-1 infections seem to be related to contact with active infections ("fever blister" or "cold sores") in the immediate family during the perinatal period. HSV-2 is usually transmitted during passage through the birth canal or by transplacental mechanisms. typically occurs within the first 2 weeks postpartum and may be unilateral or bilateral. It may be the first presentation of a herpes infection, or it may follow vesicular lesions on the skin or lid margins.

 nonspecific lid edema moderate injection of the bulbar conjunctiva, and usually nonpurulent Microdendrites or geographic ulcers, rather than typical herpetic dendrites The exudate contains mononuclear cells or, if there is a conjunctival membrane, polymorphonuclear leukocytes.

 clinical suspicion is enhanced by a maternal history of herpetic infection, the presence of a dendrite, or evidence of herpetic infection elsewhere on the body.

BACTERIAL CONJUNGTIVITIS
Bacterial Conjunctivitis Typically described as presenting on the 5th day of life. Gram +: S. aureus, S. pneumoniae,
Streptococcus viridans, and S.epidermidis.

Gram -: Haemophilus sp , Escherichia coli,Proteus sp, Klebsiella pneumoniae,Enterobacter sp, and Serratia marcescens

OPHTHALMIA NEONATORUM

: J O N AT H AN C . S O N G . N e o n a t a l C o n j u n c t i v i t i s ( O p h t h a l m i a N e o n a to r u m ) . D u a n e s o p h t h a l m o l o gy o n C D r o m , 2 0 0 6 e d i t i o n

:The atlas of emergency medicine 3rd edition by Kavin J. Knoop

REFERENCE
Cred. Reports from the obstetrical clinic in Leipzig. Prevention of eye inflammation in the newborn. Am J Dis Child . Jan 1971;121(1):3-4. [Medline]. Kavin J.Snoop.The atlas of emergency medicine 3 rd edition. Centers for Disease Control and Prevention